Provider Demographics
NPI:1295985844
Name:MARTINEZ, IRIS MARGOTH (MSED)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:MARGOTH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HUGUENOT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6387
Mailing Address - Country:US
Mailing Address - Phone:347-297-1880
Mailing Address - Fax:914-740-4846
Practice Address - Street 1:255 HUGUENOT ST APT 1110
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6396
Practice Address - Country:US
Practice Address - Phone:347-297-1880
Practice Address - Fax:914-740-4846
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074729179252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency